The Consensus Model for
APRN Regulation
Licensure, Accreditation,
Certification, Education
Presented By:
Carol Hartigan, MA, BSN, RN
Certification Programs Strategist
“Heard” on social media…
“By 2015, all Clinical Nurse Specialists will need to have their DNP in order to keep
practicing.”
“This credentialing controversy only gets more complicated as they change the exams and
the credentials given out. ALL should be accepted equally. ”
“Georgia has reached out to the National Council of State Boards of Nursing and other
professional organizations requesting they intervene as currently half the CNSs in the state
are forced back into school and/or clinical so they can sit for certification exams.
“The Consensus Model regulations are aimed more at making money for the Universities by
requiring more education than benefiting patient care which is the ultimate goal.”
Webinar Objectives
• Identify how the Consensus Model for APRN
Regulation will change the practice of CNSs or NPs
• Discuss nursing program curricula changes needed
to be ready for the new regulatory model by the
2015 deadline
• For students going forward
• For current CNSs
• Consider opportunities to positively influence
implementation of the model in your educational
program
1. What do the Consensus Model for APRN Regulation and
the AACN-Colleges DNP Initiative have in common?
2. What are the components of a certification examination
which ensure regulatory sufficiency?
3. What steps would a currently-certified Adult
Acute/Critical Care Nurse CNS take to become
nationally certified as an Adult-Gerontology Acute Care
Nurse CNS?
4. When will the Boards of Nursing begin to require the
DNP to take the certification exams?
Key Regulatory Issues in
Advanced Practice
http://journals.lww.com/aacnadvancedcriticalcare/Fulltext/2011/01000/APRN_Regula
tion__The_Licensure_Certification.8.aspx
Who and How to Regulate?
Medicine
Nursing
Who and How to Regulate?
Medicine
Nursing
Who and How to Regulate?
Registered
Nurse
Advanced
Practice
Registered
Nurse
Who and How to Regulate?
Primary
Care
APRN
Acute
Care
APRN
Who and How to Regulate?
Neonatal
Pediatric
Adult
Gero
Regulatory Concerns
• Inconsistency across APRN educational programs
• Lack of knowledge of/control over APRN
certification examination programs
• “Proliferation of subspecialties”
• Practice beyond or outside of scope as determined
by education and certification
• Inconsistent enforcement of certification eligibility
requirements
Reaching Consensus
Key Issues Identified
•
Who is an APRN? What characterizes APRN practice?
•
Primary care vs. Acute care – what are the differences and what is
the overlap?
•
What are the similarities and what are the differences among the
four roles related to educational preparation, scope of practice,
educational accreditation and regulation?
•
How does the age of the patient fit into the population-focused
model?
•
Where does “specialty” preparation fit in the model?
•
What is the best model for the future needs of patients and
families?
APRN Licensure
How did we get here anyway?
NCSBN
Historical Position Statements and Activities
1986 – NCSBN adopts a position paper on Advanced Clinical Nursing Practice
•
Determines that the educational requirement should be a minimum of a
Master’s degree and
•
The preferred method of regulation of advanced nursing is
designation/ recognition
1993 - NCSBN adopts Model Legislative Language and Model Administrative
Rules for Advanced Nursing Practice and the position paper on the
regulation of advanced nursing practice
•
Moves the recommended method of regulation of advanced nursing from
designation/recognition to licensure. This change was made due to the
fact that the activities of the practitioners are complex, require
specialized knowledge and skill, and independent decision making.
There is an established scope of practice and prequalification for safe
practice must be determined by licensing boards. Because of potential
harm to the public, licensure affords the ability to discipline practitioners
•
Directs the Board of Directors continue collaboration with the American
Nurses Association, American Association of Nurse Anesthetists,
American College of Nurse-Midwives and other nursing organizations,
including nurse certifying bodies.
NCSBN
Historical Position Statements and Activities
1994 - NCSBN performs a study to identify core competencies of nurse
practitioners and a study exploring the regulatory, fiscal and
political implications of developing a core competency
examination for nurse practitioners.
1995 – NCSBN collaborates with NP certification organizations to move
toward legally defensible examinations and processes and third-party
accreditation.
2000 – NCSBN collaborates with APRN stakeholders to develop Uniform
Advanced Practice Registered Nurse Licensure/Authority to Practice
Requirements, which serve as the foundation for the APRN Compact.
2002 – NCSBN Board of Directors approves the Advanced Practice Advisory
Committee’s Position Paper on the Regulation of Advanced Practice and
the Requirements for Accrediting Agencies and the Criteria for
Certification Programs which delineates required elements of
certification programs that would result in a legally defensible
examination suitable for the regulation of APRNs.
History of the Model
The Alliance for APRN Regulation
•
Established in 1997 by AACN-Colleges and CCNE as The Alliance for Nursing
Accreditation
•
Goal to establish a framework and mechanism to foster collaboration among the
regulatory bodies that oversee or review baccalaureate and graduate education
•
Original membership included:
•
•
•
•
•
•
•
•
•
•
•
•
•
American Academy of Nurse Practitioners Certification Program
American Association of Colleges of Nursing
American College of Nurse-Midwives Division of Accreditation
American Nurses Credentialing Center
Association of Faculties of Pediatric Nurse Practitioners
Commission on Collegiate Nursing Education
Council on Accreditation of Nurse Anesthesia Educational Programs
National Certification Corporation
National Council of State Boards of Nursing
National Organization of Nurse Practitioner Faculties
National Association of Nurse Practitioners in Women's Health, Council on Accreditation
National Certification Board of Pediatric Nurse Practitioners & Nurses (Pediatric Nursing
Certification Board)
Added AACN Certification Corporation to membership in February 2002 and National
Association of Clinical Nurse Specialists in October 2003
History of the Model
The Alliance for APRN Regulation
•
In March 2004, AACN-Colleges and NONPF submitted a proposal
to the Alliance to establish a process to develop a consensus
statement on the credentialing of advanced practice nurses
(APNs)
•
Thirty-two organizations participated in the APN Consensus
Conference in June 2004 to initiate an in-depth examination of
issues related to APN definition, specialization, sub-specialization,
and regulation, which includes accreditation, education,
certification and licensure.
•
A smaller work group made up of designees from twenty-three
organizations with broad representation of APN certification,
licensure, education, accreditation, and practice was charged
with development of a statement that addressed the issues,
delineated during the APN Consensus Conference with the goal of
envisioning a future model for APNs.
History of the Model
Parallel Processes
•
The Alliance APN Consensus Work Group convened for sixteen days of
intensive discussion between October 2004 and July 2007 to develop a
working model.
•
In a parallel process, the National Council of State Boards of Nursing
(NCSBN) APRN Advisory Panel had been drafting an APRN Vision Paper to
provide direction to boards of nursing regarding APRN regulation for the next
8-10 years by identifying an ideal future APRN regulatory model.
•
The NCSBN Board of Directors disseminated the draft Vision Paper to Boards
of Nursing and APRN stakeholders in April 2006 for feedback.
•
A Joint Dialogue Group consisting of representatives from the APRN
Consensus Work Group and the NCSBN APRN Advisory Panel convened to
craft one, consensus-based APRN regulatory document which would be
future-oriented and promote patient safety and public protection.
•
Report of the Joint Dialogue Group was agreed to by both stakeholder groups
and released on July 7, 2008.
Boards of Nursing Endorse
Consensus Model through
Model Documents
https://www.ncsbn.org/Article_XVIII_1.31.11.pdf
NCSBN
Model Nurse Practice Act
APRN Scope of Nursing Practice
• APRNs are expected to practice as licensed independent
practitioners within standards established and/or
recognized by the BON. Each APRN is accountable to
patients, the nursing profession and the BON for complying
with the requirements of this Act and the quality of advanced
nursing care rendered; for recognizing limits of
knowledge and experience; planning for the
management of situations beyond the APRN’s
expertise; and for consulting with or referring patients to
other health care providers as appropriate.
APRNs are accountable for:
• Health promotion
• Assessment, diagnosis, and management of patient
problems
• Which includes the use and prescription of
pharmacologic and non-pharmacologic
interventions
An APRN is an individual who has:
• Completed an accredited graduate-level educational
program
• Passed a national certification examination that
matches the educational preparation
• Acquired advanced clinical skills and knowledge
An APRN is an individual who has:
• Practice built upon the competencies of a RN
• Clinical experience of sufficient depth and breadth
to reflect the intended license
• Obtained a license to practice as an APRN in one of
the four roles
• Advanced clinical knowledge and skills to
provide direct care to patients is a
defining component of practice
• All APRNs have a significant component of
education and practice focusing on direct
care of individuals
APRN Regulatory Model
Licensure occurs at
Levels of Role &
Population Foci
APRN Specialties
Focus of Practice beyond role and population focus
Linked to health care needs Examples include but are not limited to:
Oncology, Older Adults,
Orthopedics, Nephrology, Palliative care
POPULATION FOCI
Family/Individual
Across lifespan
AdultGerontology
Women’s Health/
Gender Related
Neonatal
Pediatrics
Psych/Mental
Health
APRN ROLES
Nurse
Anesthetist
Nurse
Midwife
Clinical Nurse
Specialist ++
Nurse
Practitioner +
+The certified nurse practitioner (CNP) is prepared with the acute care CNP competencies and/or the primary care CNP
competencies. At this point in time the acute care and primary care CNP delineation applies only to the pediatric and adultgerontology CNP population foci. Scope of practice of the primary care or acute care CNP is not setting specific but is based on
patient care needs. Program may prepare individuals across both the primary care and acute care CNP competencies. If programs
prepare graduates across both sets of roles, the graduate must be prepared with the consensus-based competencies for both roles
and must successfully obtain certification in both the acute and the primary care CNP roles. CNP certification in the acute care or
primary care roles must match the educational preparation for CNP’s in these roles.
++The Clinical Nurse Specialist (CNS) is educated and assessed through national certification processes across the continuum
from wellness through acute care.
+ The Clinical Nurse Specialist (CNS) is
educated and assessed through national
certification processes across the
continuum from wellness through acute
care.
…just a few words about the
clinical nurse specialist role for
those with blended and/or postgraduate programs…
+Nurse Practitioner
• The certified nurse practitioner (CNP) is prepared
with the acute care CNP competencies and/or the
primary care CNP competencies.
• At this point in time the acute care and primary
care CNP delineation applies only to the pediatric
and adult-gerontology CNP population foci.
+Nurse Practitioner
• Scope of practice of the primary care or
acute care CNP is not setting specific but is
based on patient care needs.
• Programs may prepare individuals across
both the primary care and acute care CNP
competencies.
+Nurse Practitioner
• If programs prepare graduates across both sets
of roles, the graduate must be prepared with
the consensus-based competencies for both
roles and must successfully obtain certification
in both the acute and the primary care CNP
roles. CNP certification in the acute care or
primary care roles must match the educational
preparation for CNPs in these roles.
For entry into APRN practice and for regulatory
purpose the APRN education must:
• Be a formal accredited graduate or post-graduate certificate
program in an academic institution. The program must be
comprehensive and on the graduate level
• Be awarded pre-approval, pre-accreditation or accreditation
status prior to admitting students
• Prepare graduates in one of four roles and in at least one of
the population foci
For entry into APRN practice and for regulatory
purpose the APRN education must:
• Include at least three separate comprehensive
graduate level courses in the APRN core
• Advanced Physiology/Pathophysiology
• Advanced Health Assessment
• Advanced Pharmacology
For entry into APRN practice and for regulatory
purpose the APRN education must:
• Provide basic understanding of decision-making
principles
• Ensure clinical and didactic coursework is
comprehensive to prepare the graduate to practice
in the APRN role and population foci
• More focused area of practice than role
and population foci
• Specialty preparation cannot replace
educational preparation in the role or one of
the six population foci
• Specialty preparation cannot expand one’s
scope of practice beyond the role and
population focus
• Addresses a subset of the population-focus
• Definition built on ANA (2004) Criteria for Recognition
as a Nursing Specialty
• The title may not be used in lieu of the
licensing title, which includes the role and
population
• Is developed, recognized and monitored by
the profession
APRN regulation includes:
– Licensure
• The granting of authority to practice
– Accreditation
• Formal review and approval by a recognized agency of
educational degree or certification programs in nursing or
nursing related programs
– Certification
• The formal recognition of knowledge, skills and experience
demonstrated by the achievement of standards identified
by the profession
– Education
• The formal preparation of APRNs in graduate or postgraduate programs
Boards of Nursing will:
• License APRNs in one of four roles with a
population focus
• Be solely responsible for licensing (exception for
states where boards of midwifery regulate nursemidwives and midwives)
• Only license graduates of accredited graduate
programs
Boards of Nursing will:
• Require successful completion of a national
certification examination that assesses APRN core,
role and population competencies
• Only license an APRN when education and
certification are congruent
• Not issue a temporary license
• License APRNs as independent practitioners with no
regulatory requirements for collaboration, direction
or supervision
Boards of Nursing will:
• Have at least one APRN representative position on
the board and utilize an APRN advisory committee
that includes representatives of all four APRN roles
• Institute a grandfathering clause that will exempt
those APRNs already practicing in the state from
new eligibility requirements
• Have the option for mutual recognition of advanced
practice nursing through the APRN Compact
Accreditors will:
• Evaluate APRN graduate degree and post-graduate
certification programs
• Through their established accreditation standards
and process, assess APRN education programs in
light of the APRN core, role core and population
core competencies
Accreditors will:
• Assess developing APRN education programs and
tracks by reviewing them using established
accreditation standards and granting pre-approval, preaccreditation or accreditation prior to student
enrollment
• Include an APRN in the visiting team when reviewing
an APRN program
• Monitor the APRN education programs throughout the
accreditation period
Foundational Requirements
for Certification
Certification programs providing APRN
Certification used for licensure will:
• Follow established certification testing and psychometrically
sound, legally defensible standards for APRN examinations for
licensure
• Assess the APRN core and role competencies across at least
one population focus of practice
• Assess specialty competencies separately from the APRN core,
role and population focused competencies (example: AdultGerontology CNS and Oncology CNS will take two separate certification
examinations)
Foundational Requirements
for Certification
Certification programs providing APRN
Certification used for licensure will:
• Be accredited by a national certification
accreditation body (ABNS or NCCA; role of NCSBN
APRN Committee)
• Enforce congruence between the education
program and the type of certification examination
- exam name matches transcript
Key Elements - Certification
Educational eligibility requirements met:
• 3 Ps
• Required number of didactic courses in population focus
• Sufficient supervised clinical hours in population focus
• Educational program prepared graduate to be eligible to sit for
the nationally recognized certification that corresponds to the
APRN role and population focus for which the student was
prepared in the program.
• Degree awarded on transcript matches examination name
APRN educational programs/tracks leading to
eligibility for a APRN license will:
• Follow established educational standards and ensure
attainment of the APRN core, role core and population
core competencies
• Be accredited by a nursing accrediting organization that
is recognized by the U.S. Department of Education
and/or the Council for Higher Education Accreditation
APRN educational programs/tracks leading to
eligibility for a APRN license will:
• Be pre-approved, pre-accredited, or accredited prior to
the acceptance of students, including all developing
APRN education programs and tracks
• Ensure that graduates of the program are eligible for
national certification and state licensure
• Ensure that official documentation (e.g. transcripts)
specifies the role and population focus of the graduate
RN Licensure Model
• Initial licensure is based on a combination of individual
jurisdictional requirements (criminal background, good moral
character, etc.), prescribed educational qualifications and
successful completion of national examination.
• Depending on statutory authority, Board of Nursing may or
may not perform individual “approval” of pre-licensure
educational programs. Five individual state boards of nursing
are separately recognized as accrediting agencies by the U.S.
Department of Education.
• Some jurisdictions consider approval of educational programs
an accountability that may not be delegated to another entity;
not all Boards of Nursing have statutory oversight of APRN
educational programs, and not all APRN programs are located
within schools of nursing.
RN Licensure Model
• All US Boards of Nursing utilize the NCLEX-RN examination.
• Boards are afforded the option to periodically review NCLEXRN exam “forms” for compliance with their state practice acts.
• Board members and staff may participate as volunteers on
NCSBN examination committees and Boards nominate NCLEX
item writers and exam development committee members, so
in this way are active participants and stakeholders in their
licensure exams. Changes to the passing standard must be
approved by the NCSBN Board of Directors.
• Changes in exam fees, test plans and eligibility requirements
are determined by the NCSBN Delegate Assembly.
It’s a Whole New Ballgame
• Certification examinations become “high stakes” exams
with accompanying legal vulnerabilities.
• Certifiers enter into agreements with individual Boards
of Nursing as Boards “delegate state authority” for
assuring educational eligibility.
• Graduate faculty are now accountable for preparing
students for professional licensure examinations where
in many instances this had not previously been the case
(mostly CNS programs and other APRN types in states
where national certification is not required for practice).
It’s a Whole New Ballgame
• Career mobility, tele-health initiatives, interstate ACOs,
delayed retirement and consulting opportunities
increase the likelihood that APRNs may need to qualify
for licensure in other jurisdictions throughout the
course of their careers, making it essential that all
educational eligibility requirements are met, fully
documented, and that documentation is retained for
future use.
• Educational eligibility requirements vary from vague to
extremely detailed, depending on the jurisdiction;
graduates must be qualified for licensure in any state,
not just the state in which they are educated.
Why Does It Matter?
What difference does it make whether or not a is a
CNS is categorized as an APRN in my state, as long
as I have title protection?
• Employment opportunities
• Reimbursement
• Salary
Regulatory Sufficiency
For a licensure or certification examination to meet
the standards for regulatory sufficiency, it must meet
the following criteria:
1. Be targeted to entry level practice
2. Measure only job-related knowledge, skills, and
abilities
3. Require demonstration of competence at the
minimum level necessary for safe and effective
practice
4. Be psychometrically sound
Get with the Guidelines
• AACN-Colleges Master’s or Doctoral Essentials
• NCSBN Criteria for APRN Certification Programs
• Adult-Gerontology Clinical Nurse Specialist
Competencies
• AACN – Critical-Care Scope & Standards of Practice for
the Clinical Nurse Specialist in Acute and Critical Care
• Other Population-based or Specialty-focused Scope &
Standards documents
Get with the Guidelines
• National Consensus Core CNS Competencies
• NACNS Criteria for the Evaluation of Clinical Nurse
Specialist Master’s, Practice Doctorate, and PostGraduate Certificate Educational Programs
• State Nurse Practice Acts and Administrative Rules
• AACN Certification Corporation Adult-Gerontology,
Pediatric and Neonatal Acute Care Clinical Nurse
Specialist Job Analyses and Test Plans and/or American
Nurses Credentialing Center’s Adult-Gerontology and
Pediatric Clinical Nurse Specialist Job Analyses and Test
Plans when available.
Adult-Gerontology
CNS Competencies
New CNS Resource Docs
Consensus Model Based CNS
Examinations and Test Plans
Moving Forward
How Do I Get From Here to There?
Adult Acute
and Critical
Care CNS
G
A
P
Adult-Gero
Acute Care
CNS
What Do I Have to Take?
From NONPF NP NTF Criteria: (exemplar)
III.F Post-master’s students must successfully
complete graduate didactic and clinical
requirements of a master’s NP program through a
formal graduate level certificate or master’s level
NP program in the desired area of practice. Postmaster’s students are expected to master the same
outcome criteria as master’s NP students. Postmaster’s students who are not already NPs are
required to complete a minimum of 500 supervised
clinical hours.
What Do I Have to Take?
•
Special consideration should be given to NPs expanding into
another NP population-focused area of practice by allowing
them to challenge selected courses and experiences; however,
didactic and clinical experiences shall be sufficient to allow the
student to master the competencies of the new area of NP
practice.
•
These students must complete a sufficient number of clinical
hours to establish competency in the new population-focused
area of practice.
•
Programs should be able to document waivers and exceptions
for individual students through a gap analysis.
NTF Criteria Appendix F
What Do I Have to Take?
From NACNS Criteria for the Evaluation of Clinical
Nurse Specialist Master’s, Practice Doctorate, and
Post-Graduate Certificate Educational Programs:
• Post-graduate certificate program graduates are
expected to meet the same CNS competencies as
master’s or practice doctorate program graduates.
• Evidence that validates a minimum of 500 clinical
(clock) hours in the master’s and post-graduate
certificate CNS program.
New Exam Timeline
AACN Certification Corporation
• Adult-Gerontology, Pediatric and Neonatal wellness-throughacute care CNS Analyses completed and Test Plans posted at
http://www.aacn.org/WD/Certifications/Content/APRN-CNSProgram-Resources.pcms?menu=certification
• Pilot testing of the new examinations will begin with selected
groups of senior students begins in February 2013.
• New exam release scheduled for June 2013 with instant
scoring if sufficient numbers of pilot testers are recruited.
• Current Adult, Pediatric and Neonatal CCNS exams will be
administered through December 31, 2014. Current CCNS
credential will be maintained as long as there are current
certificants in practice who require it.
1. What do the Consensus Model for APRN Regulation and
the AACN-Colleges DNP Initiative have in common?
2. What are the components of a certification examination
which ensure regulatory sufficiency?
3. What steps would a currently-certified Adult
Acute/Critical Care Nurse CNS take to become
nationally certified as an Adult-Gerontology Acute Care
Nurse CNS?
4. When will the Boards of Nursing begin to require the
DNP to take the certification exams?
Audience Questions
Contact Us
Please let us know if you would like more
information, have suggestions for us, or
would like to get involved as we
“relentlessly communicate” details and
updates about the implementation of the
Consensus Model for APRN Regulation.
AACN Certification Corporation
(800) 899-2226 or certcorp@aacn.org